1. Field of the Invention
The present invention pertains to surgical instruments and procedures and, more particularly, to an instrument and method for performing various procedures during endoscopic and open surgery.
2. Discussion of the Related Art
Endoscopic and minimally invasive medical procedures, such as laparoscopy, have become widely accepted for surgery and diagnosis due to the associated advantages relating to reduced trauma and hospitalization time. The performance of an endoscopic procedure typically involves the creation of puncture sites through a wall of an anatomical cavity using penetrating instruments including an obturator, such as a trocar, disposed within a portal sleeve. After the penetrating instrument has penetrated into the anatomical cavity, the obturator is withdrawn leaving the sleeve in place to form a portal in the cavity wall through which endoscopes are introduced to view the surgical site and through which instruments having end effectors, such as forceps, cutters, needle holders, staplers, clip applicators and the like, are introduced at the surgical site. The end effectors are typically disposed at the distal end of the instrument and are manipulated by the surgeon using controls disposed at the proximal end of the instrument.
It is common in endoscopic procedures to use multiple end effectors in combination. However, typical endoscopic instruments include only one end effector, requiring several incisions for placement of multiple portal sleeves to accommodate a suitable number of endoscopic instruments for performing the required functions. Recently, however, in U.S. patent application Ser. No. 08/758,648, now U.S. Pat. No. 5,759,188; Ser. No. 08/847,182 and Ser. No. 08/877,764; it has been proposed to provide a plurality of end effectors on a single endoscopic instrument to minimize the number of puncture sites and thus reduce the risk and healing time associated with endoscopic surgery. The aforementioned patent applications disclose instruments having multiple needle holders movable with respect to one another to suture anatomical tissue; however, it would be desirable to incorporate other types of end effectors into a single endoscopic instrument so that the end effectors can be moved with respect to one another in a similar manner. Also, it would be desirable to move various types of end effectors through predetermined paths, such as an arc, to manipulate tissue without repositioning the entire endoscopic instrument. The needle holders described in the aforementioned patent applications can include distal portions that extend laterally outward at an angle from the instrument to provide a wide range of relative movement for suturing a wide range of tissue sizes. It would also be desirable to provide a wide range of relative movement between various types of end effectors to permit other operative acts or functions to be performed on a wide range of tissue sizes.